Undiagnosed Diseases (UD) are constellations of significant signs, symptoms and/or test results that are seen by specialists over time without discovery of their cause(s), and for which diagnostic procedures and tests have been exhausted. The goal of the Undiagnosed Disease Network (UDN) is to diagnose UDs and bring answers that give afflicted individuals hope and ways to improve their health. Our Vanderbilt UDN Clinical Site (VCUD) is an ideal milieu of excellent patient oriented care, and collaborative research. We formed the VCUD by combining unique Vanderbilt resources with UDN resources to diagnose difficult UDs. Vanderbilt resources include: 1) a productive Clinical and Translational Science Award that hosts a large Clinical Research Center (CRC) that has grown, evolved, and developed an outstanding cohort of clinicians and physician scientists, 2) a strong, dedicated group of Pediatricians, Internists, Neurologists and Geneticists, 3) bioinformatics experts, 4) the BioVU DNA databank and experts, 5) structural biology investigators, 6) our EMR and REDCap database, and 7) a strong focus on educating and training the next generation who will help sustain the UDN over the long-term. We have combined our VCUD team (physicians, bioinformatics experts, research scientists, Study Coordinator, NPs, GCs), with UDN resources to diagnose UD patients by the following: A) gathering and analyzing clinical data to form differential diagnoses (clinical hypotheses), B) analyzing next generation sequencing and other test data to form testable gene hypotheses, C) utilizing unique VUMC resources including BioVU, PrediXcan, and Structural Biology to prioritize candidate variants (CV), D) determining the functional effects of non-coding CV, E) testing and merging our clinical and genetic hypotheses to identify concordant disorders and CV that cause the patients' UD, and F) using VCUD Studios to discover new diseases and promote translational research to determine mechanisms and lead to treatments. Using this approach, we have diagnosed 39/50 UDN cases evaluated by our VCUD to date. We hypothesize that we can use VCUD teams to merge patient care with translational research by synergistically combining them with distinct VUMC resources to more efficiently diagnose and treat UD patients. Our VCUD structure will provide the workflow, throughput, and passion needed to test our hypotheses and diagnose and provide treatment recommendations. We will enhance all these activities in the Phase II (UO1) expansion through collaborations with the UDN, the Veteran's Administration, Precision Medicine Projects and health care insurers, to produce an evolving and more sustainable model. Thus, we will accelerate merging patient oriented specialty care with translational research to improve the diagnosis, care, and understanding of patients with UD by our specific aims to: 1) Improve the diagnosis and care of UD patients of all ages, 2) Determine causes of and improve treatment options for UD, and 3) Test the hypothesis that BioVU and Structural Biology can be used as an integrated approach to identify causative variants in UDN patients. !

Public Health Relevance

The Vanderbilt Center for Undiagnosed Disease will function in the NIH funded Network of Undiagnosed Diseases to evaluate persons afflicted with undiagnosed illnesses and to share information with the Network that will best ensure that an accurate and timely diagnosis can be made, that counseling and advice be given to the patient and care givers, and that newly described diseases be appropriately studied and researched in order to improve health of the patient and to assist in diagnosing and treating similar patients in the whole human population.

Agency
National Institute of Health (NIH)
Institute
National Human Genome Research Institute (NHGRI)
Type
Research Project--Cooperative Agreements (U01)
Project #
2U01HG007674-06
Application #
9593388
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Wise, Anastasia Leigh
Project Start
2014-09-01
Project End
2022-06-30
Budget Start
2018-09-19
Budget End
2019-06-30
Support Year
6
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Type
DUNS #
079917897
City
Nashville
State
TN
Country
United States
Zip Code
37232
Sivley, R Michael; Sheehan, Jonathan H; Kropski, Jonathan A et al. (2018) Three-dimensional spatial analysis of missense variants in RTEL1 identifies pathogenic variants in patients with Familial Interstitial Pneumonia. BMC Bioinformatics 19:18
Splinter, Kimberly; Adams, David R; Bacino, Carlos A et al. (2018) Effect of Genetic Diagnosis on Patients with Previously Undiagnosed Disease. N Engl J Med 379:2131-2139
Pomerantz, Daniel J; Ferdinandusse, Sacha; Cogan, Joy et al. (2018) Clinical heterogeneity of mitochondrial NAD kinase deficiency caused by a NADK2 start loss variant. Am J Med Genet A 176:692-698
Cassini, Thomas A; Robertson, Amy K; Bican, Anna G et al. (2018) Phenotypic heterogeneity of ZMPSTE24 deficiency. Am J Med Genet A 176:1175-1179
Ramoni, Rachel B; Mulvihill, John J; Adams, David R et al. (2017) The Undiagnosed Diseases Network: Accelerating Discovery about Health and Disease. Am J Hum Genet 100:185-192
Zastrow, Diane B; Zornio, Patricia A; Dries, Annika et al. (2017) Exome sequencing identifies de novo pathogenic variants in FBN1 and TRPS1 in a patient with a complex connective tissue phenotype. Cold Spring Harb Mol Case Stud 3:a001388
Shashi, Vandana; Pena, Loren D M; Kim, Katherine et al. (2016) De Novo Truncating Variants in ASXL2 Are Associated with a Unique and Recognizable Clinical Phenotype. Am J Hum Genet 99:991-999
Bashamboo, Anu; Donohoue, Patricia A; Vilain, Eric et al. (2016) A recurrent p.Arg92Trp variant in steroidogenic factor-1 (NR5A1) can act as a molecular switch in human sex development. Hum Mol Genet 25:3446-3453
Chen, Xinping; Talati, Megha; Fessel, Joshua P et al. (2016) Estrogen Metabolite 16?-Hydroxyestrone Exacerbates Bone Morphogenetic Protein Receptor Type II-Associated Pulmonary Arterial Hypertension Through MicroRNA-29-Mediated Modulation of Cellular Metabolism. Circulation 133:82-97
Kropski, Jonathan A; Pritchett, Jason M; Zoz, Donald F et al. (2015) Extensive phenotyping of individuals at risk for familial interstitial pneumonia reveals clues to the pathogenesis of interstitial lung disease. Am J Respir Crit Care Med 191:417-26

Showing the most recent 10 out of 16 publications